Imagine a regular patient comes in for a consultation and complains of being sick and tired of being sick and tired. He states that, while your care has always been helpful, the correction doesn't last. He is disappointed with his medical care, as well, since it has not solved the problem. His present complaints are of frequent suboccipital headaches and continual fatigue bordering on exhaustion. He may also list as a chief complaint any or many of the symptoms at the end of this article.! (This scenario fits many of our patients;; only the secondary symptoms seem to; change.) This patient implores you to; look further into his case and asks if, there isn't something that will help him. j You know the patient suffers from a-chronic or recurring sacroiliac problem, but there is no history of trauma. An upper cervical problem is always present and adjustments relieve the headaches, but the problem always returns in a day or two. And, there is that loss of normal kyphosis between the shoulder blades. Can you offer a solution for this patient based on your findings, other than a mechanical/philosophical one? The problem of being sick and tired is1-a common one, endured by patient and doctor, alike. We all have experienced it; at one time or another. Fortunately, aj rest or vacation, a good diet, and being! removed from the source of stress seem to do the trick for most of us. Unfortunately, others do not recover as quickly, and the feelings of fatigue and exhaus-' tion continue unabated and, often, can lead to accusations of hypochondria and1 even mental disturbance. Prescription drugs for the problem seem to be getting stronger and more specifically directed' at certain body processes, yet the condi- '■ tion is generally increasing within the population as a whole. We are often told this is due to better diagnostic abilities; just the same, there don't seem to be any objective tests to define the problem. In recent years, the concept of Chronic Fatigue Syndrome (CFS) has been put forth, and objective studies have shown a compromised immune system to be involved. In a previous column, I discussed the role of stress and protein in the "Sick and Tired Syndrome", as well as the role of protein in maintaining homeostasis. Of course, the adrenal glands are the first affected by stress; and, in this column, I would like to carry that discussion forward and address the role of the adrenal glands in protein metabolism. This will include a possible reason for the symptoms of chronic fatigue, as well as the compromised immune system. I believe it can be shown that the solution for this pervasive problem is to be found within a chiropractic/nutritional paradigm, and not a pharmaceutical one. A lot is at stake here: After all, whoever can specialize in this disorder and get consistent results will be richly rewarded in many ways. It is entirely predictable that researchers should turn their attention to the hypothalamic-pituitary-adrenal axis for an explanation of CFS, and a multitude of studies have shown it is often altered. In other words, patients consistently show decreased levels of the steroid hormone, cortisol (from the adrenal glands), and increased levels of the pituitary hormone, adrenocorticotropic hormone (ACTH). Obviously, the hypo-thalamus is attempting to maintain homeostasis by having the pituitary gland secrete excess ACTH to stimulate the adrenal cortex to produce cortisol. The adrenal gland is unable to comply with adequate amounts of this most potent of the glucocorticoids, and the pituitary continues to send more ACTH. Eventually, corticotropin releasing factor (CRF) is unable to stimulate adequate ACTH production. This relationship between the hypo-thalamus, pituitary, and adrenal glands is vitally important, because of the glands' involvement in every stressful situation, regardless of a mechanical, emotional, or chemical (nutritional) cause. FUNCTIONS OF CORTISOL Cortisol does the following: . regulates the metabolism of fats, carbohydrates, sodium, potassium, and proteins; influences the nutrition and growth of connective (collagenous) tissues such as bone, ligament, cartilage, tendon, muscle, and skin; and regulates the immune system in many ways. Cortisol is the primary glucocortical hormone. It is synthesized from cholesterol in the adrenal cortex, the cholesterol being transported from the liver to the adrenals by plasma protein. One of its primary effects is to elevate blood glucose levels. It does this by pulling amino acids from skeletal muscle and increasing their conversion in the liver to glucose, in a process called gluconeogene-sis. It is often forgotten that 57% of our protein intake is normally converted to glucose in the liver anyway, and this activity is increased by sympathetic stimulation in response to stress (fight or flight). Continued on page 15... CHIROPRACTIC, CHRONIC FATIGUE, AND THE ADRENAL GLANDS ..from page 12 Stress of almost any kind will cause an immediate, pronounced rise in ACTH blood levels, followed within minutes by an increase in the secretion of corti-sol. The ability of the body to cope normally with the stress depends on this process. An inability of the adrenal gland to respond to ACTH or sympathetic stimulation, because of exhaustion or protein deficiency, accounts for many of the symptoms associated with chronic fatigue. The foregoing clearly provides an alternative explanation for some of the findings in this syndrome. Instead of an infection caused by some elusive virus (Epstein-Barr) or other microorganism, adrenal gland fatigue would account for the various deficits and compensations usually seen in chronic fatigue, depending on the individual's heredity, environment, and diet. As you will see, this explanation also accounts for the common history of some inflammatory incident that precedes CFS. Traumatic incident(s) only stress the already depleted adrenals further. This stress would be especially dis- ruptive, if anti-inflammatory medica- tions or high-potency, crystalline-pure vitamin fractions were used to interfere with any stages of inflammation and repair. ANTI-INFLAMMATORY AND ANTI-ALLERGIC EFFECTS OF GLUCOCORTICOIDS Normal cortisol secretion in response to stress accomplishes the following: stabilizes lysosomal enzymes; depresses the vasodilator action of histamine; and . reduces capillary permeability. In high concentrations (prescription strength), cortisol causes: impairment of the migration of phag ocytes resulting in atrophy of all lymphoid tissue and, consequently, a reduction in the number of lympho cytes and antibodies in circulation. Because of these actions, glucocorti-coids are used to treat a number of diseases, including rheumatoid arthritis (in which the damage is caused by the inflammatory reaction), and allergic disorders (such as hay fever, allergic dermatitis, and asthma, in which inflammation or other consequences of anaphylaxis have disturbing effects). In rheumatoid arthritis, stabilization of the lysosomal enzymes prevents the release of cellular enzymes that destroy deposits of foreign material on cell surfaces (in this case, bone). This appears to be the major factor in alleviating the painful consequences of the disease. In some types of anaphylaxis, administration of cortisol has a lifesaving effect by preventing death from shock. EFFECT OF GLUCOCORTICOIDS ON BLOOD CELLS Glucocorticoids also play a permissive role in the production of red blood cells. Deficiency in glucocorticoids often results in anemia, whereas hypersecre-tion of glucocorticoids usually causes polycythemia. High concentrations of glucocorticoids also cause rapid destruction of eosinophils. Eosinopenia is one of the diagnostic features of excessive secretion of glucocorticoids. These laboratory findings are inconsistent with a primary adrenal insufficien-cy-that is, with a clinical or serious disease. A pituitary disease is also unlikely. Therefore, a simple subclinical adrenal fatigue would clearly explain the findings. Subclinical adrenal fatigue could, especially in conjunction with a subclinical vitamin B complex deficiency, also account for what is called neurally mediated hypotension found in some CFS patients. This disorder is triggered when the body's nervous system incorrectly adjusts blood pressure and heart rate. Faintness (dizziness, loss of postural tone, lightheadedness) caused by diminished cerebral blood flow is common with this type of hypotension. Susceptible individuals develop an increased catecholamine (epinephrine and/or norepinephrine) response, resulting in symptoms such as vasodilation (dilation of the blood vessels), bradycar-dia (slow pulse), hypotension, stomach discomfort, nausea, pallor, blurred vision, sweating, and headaches after exercising-all parasympathetic responses. Epinephrine and norepinephrine are secreted by the adrenal medulla in response to stimulation (stress) of the sympathetic nervous system. Epinephrine causes some of the physiological expressions of fear and anxiety. A disturbance in the metabolism of norepinephrine at important brain sites has been implicated in disturbances of mood, accompanied by full or partial manic or depressive syndrome. These adrenal-produced catecholamines are important neurotransmitters, linking the . nervous system with adrenal gland function. If one or both areas are nutritionally depleted, symptoms of CFS can readily ensue. One ironic aspect of some current CFS therapies is the recommendation of a "healthy" diet, which includes no or low salt intake. Salt (specifically sodium) is imperative to adrenal gland health and function. Other trace minerals (potassium, zinc, iron, etc.), minerals (magnesium, calcium, etc.), vitamin complexes (especially the vitamin C complex with its organic copper enzyme, tyrosinase), and amino acids are, of course, also important. But adrenal exhaustion fre-quently creates sodium deficiencies, symptoms of which include muscle weakness, poor memory and concentration, anorexia, acidosis, dehydration, and tissue atrophy. A chronic vitamin B-complex deficiency syndrome can also place great stress on the adrenals. When the adrenals can no longer compensate for the demands placed on them, nervous exhaustion fo Hows. The following symptoms mirror those of persons diagnosed with CFS, but are actually the symptoms of deficiencies of the various B vitamins and their cooperative nutrients. GENERAL COMPLAINTS Unusual fatigue Exhaustion Headaches Lightheadedness to dizziness CIRCULATORY Slow pulse or fast pulse Cold hands and feet Palpitations Pain in the chest DIGESTIVE AND BOWEL ELIMINATION Soreness of the mouth Sore throat Difficulty swallowing Constipation or diarrhea Changes in appetite Craving for sweets Indigestion Stomach pains ENDOCRINE IMBALANCE Menstrual complaints Continued on page 31... CHIROPRACTIC, CHRONIC FATIGUE, AND THE ADRENAL GLANDS . from page 15 INTEGUMENT (Skin, Hair, and Nails) Acne, facial oiliness Dermatitis (dry, greasy skin) Burning feet Burning or itching of the eyes MUSCULOSKELETAL Weakness Muscle soreness NERVOUS SYSTEM/EMOTIONAL Numbness or tingling Nervous ness Restlessness Anxiety Insomnia or sleep disturbances Apprehension/vague fears Loss of ability to concentrate Flights of ideas Irritability to rage Uneasiness to panic Noise sensitivity Inability to handle stress Heightened sensitivity to pain or touch Electric shock sensations Hypochondria Mood swings Morbid thoughts Suspicions Severe depression A feeling of impending doom Loss of memory Mental confusion CHIROPRACTIC FINDINGS The adrenal glands are innervated from spinal nerves emerging from thoracic segments T9-10, but many sources go as high as T5. In my clinical experience, loss of a normal thoracic kyphosis between T5 to T9 can almost always be associated with hypoadrenal function, including low blood glucose levels and neural-mediated hypotension. Excessive parasympathetic stimulation can originate from hypermobile or unstable upper cervical and sacroiliac articulations. Excessive sympathetic stimulation can originate from hypermobile thoracic and lumbar segments, whereas the opposite effects are encountered with lack of mobility or articular fixations in these areas. Early recognition leads to preventive health care. In my opinion, non-traumatic, chronic muscle contractions, joint fixations, and postural deviations are always associated with visceral dysfunctions. Examination of viscero-somatic reflexes, coupled with a basic understanding of homeostatic mechanisms, lead to early recognition and prevention of disease. Who is better suited to provide expertise in these areas than you, doctor? Howard F. Loomis, Jr., DC, president of Enzyme Formulations, Inc., has an extensive background in enzymes and enzyme formulations. As president of 21st Century Nutrition, Inc., for fifteen years, he has forged a remarkable career as an educator, having conducted over 400 seminars to date, in the United States, Canada, Germany, and Australia, on the diagnosis and treatment of enzyme deficiency syndromes. Call 21st Century Nutrition at 1-800-662-2630 for more information. «£♦
